FEBRUARY 11, 2019
ORLANDO, FL
Machine Learning and Other Technology
www.HIMSSConference.org
#rethinkRCM
Redefining the Revenue Cycle
Technology changing how we…..Live
Technology changing how we…..Cook
Technology changing how we…..communicate
Technology changing how we…..Commute
Technology changing how we…..work
Technology changing how we provide healthcare
Technology changing our…..hospital
Technology changing our…..OR
Technology changing our…..Care delivery
Technology changing …..The Revenue Cycle
Revenue Cycle Never existedRevenue Cycle Never Always existed
“Revenue Cycle”
Medicare was enacted under
Title XVIII of Social Security Act
in 1965
70-90s
Revenue cycle management (RCM) is the financial process, utilizing
medical billing software, that healthcare facilities use to track patient
care episodes from registration and appointment scheduling to the final
payment of a balance.
Highly evolved and complex system
Revenue Cycle will continue to evolve
Accelerated growth in Technology
Revenue Cycle Evolution is Driven by margins
Technology
Regulatory Environment
New diagnosis/remedies
New diagnosis/remedies
Patient Centric
The MetroHealth System
The MetroHealth System provides nearly 1.2 million patient visits annually
at a tertiary care academic acute care hospital (which includes a Level I
Adult Trauma and Burn Center) and a skilled nursing facility.
“We treat everyone equally with dignity, candor, compassion and
empathy. We believe that people should receive health care regardless of
their financial situation.” - Akram Boutros, CEO
Hospital Overview
Hospitals
4
Emergency Departments
4
Ambulatory Sites
27
Staffed Beds
742
Employed Physicians
628
Pharmacies
9
Unique Patients
300,000
Employees
7,793
The MetroHealth System
Revenue Cycle
Information Services
Partnership
• Current Technology
• Creative use of existing
technologies
• New Technologies
• New to the system
• New to the industry
Automation
Algorithm
Artificial Intelligence
Machine Learning
Blockchain
Scheduling
Scheduling
Scheduling
• Physician Utilization up by 18%
• Wait time down by 10 min
• Patient satisfaction up by 5 points
Real Time Eligibility
RTE
Real Time Eligibility
RTE
RTE
Real Time Eligibility
RTE
RTE
In 2018
• More that 6M claims were identified with
incorrect insurance
• 6 % decline in rejection rate related to
insurance
Cash Management
Cash Management
Cash Management
• Previously 1.25 FTE was required to do the
reconciliation work. Now it takes 0.05 FTEs.
• Reconciliation process took more than 6
hours a day. Now it takes 10-15 min.
• Efficiency gain of 96%
Coding
Coding
Coding
• In Radiology, 70% coding is now automated
(Originally it was 100% manual)
• Coding related denial reduced by 3%
• 1.25 FTE repurposed for value added
functions
Payor
System
Create
Request
Letter
Print
Shop
Mail
room
Mail
room
Sort/Prep
Scan
Cart
deliveries
to ROI
Create
Medical
Record
PDF
Print
shop
Mail
room
Mail
room
Mail Cart
Work
Basket
Claim
Examiner
Sort/Prep
Scan
Approve
Nurse
Review
Deny
Payor
Provider
Document Request – Hyland Content Connect
Document Request – Hyland Content Connect
Payor
System
Cart
deliveries
to ROI
Create
Medical
Record
PDF
Payor
Provider
Hyland Content Connect
Pay claim
Nurse Review
Station
Payor System
Create eForm
(pdf)
Document Request – Hyland Content Connect
Payor
System
Cart
deliveries
to ROI
Create
Medical
Record
PDF
Payor
Provider
Hyland Content Connect
Pay claim
Nurse Review
Station
Payor System
Create eForm
(pdf)
• In early stages after implementation.
• Currently, live with Medical Mutual of Ohio.
Working with other payors
• Estimated benefits:
• Cost savings of $7 per request
• Cash acceleration by 3weeks
• FTE reallocation by 2 FTEs.
Customer Service - Voice Analytics
Customer Service - Voice Analytics
Customer Service - Voice Analytics
• Abandoned Rate
decreased 12%
• Collection grew
by 15%
Self Service Culture
T e
c h
n
o l
o
g
y
Self Service Culture
Scheduling
Registration
Check-in
Payment
Self Service Culture
Registration
Check-in
Payment
Scheduling
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Average for 2018
Average for 2019
Growth
of 96%
Bet. Avg of 18 & 19
Self Service Culture
Payment
Scheduling
Registration
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Check-in
1% of all
registration and
check-in
Self Service Culture
Scheduling
Registration
Check-in
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Payment
Growth
of 171%
Between Jan and Dec
Tele Medicine– Doc2Go
Self Service Culture
Analytics - Dashboards
Analytics - Dashboards
What we are currently working on?
Rapid Reg and Authorization - AI (Olive)
Block Chain - Opioid
